CM-YA TAM Form

Contingency Management for Youth Addiction Therapist Adherence Measure - Please check off one response (Never, Rarely, Often, Almost Always) that best answers the question about the work you, your child, and the CM-YA provider have worked on together. Some questions may not apply to you at this time so you will be able to skip those questions. Please follow the instructions in the survey for skipping questions.

Month(Required)

Client ID(Required)

Provider Name(Required)

1. The provider explained what an ABC Assessment is and why it is used.(Required)

Never / Not Yet

Rarely

Often

Almost Always

2. The provider helped my family think of relapses as "learning opportunities" rather than "failures."(Required)

Never / Not Yet

Rarely

Often

Almost Always

3. The provider talked with us about situations that might cause or "trigger" my child to use drugs.(Required)

Never / Not Yet

Rarely

Often

Almost Always

4. The provider conducted an ABC Assessment of my child's drug use.(Required)

Never / Not Yet

Rarely

Often

Almost Always

5. In the ABC Assessment, the provider made sure that "Behaviors" included things my child did to obtain drugs.(Required)

Never / Not Yet

Rarely

Often

Almost Always

6. In the ABC Assessment, the provider made sure that "Consequences" included both the positive and negative consequences of my child's drug use.(Required)

Never / Not Yet

Rarely

Often

Almost Always

7. The provider made sure that my child and I completed an ABC Assessment on our own.(Required)

Never / Not Yet

Rarely

Often

Almost Always

8. The provider used a contract with us that focused on stopping drug use in exchange for rewards.(Required)

Never / Not Yet

Rarely

Often

Almost Always

9. The provider identified my child's Most Valued Privilege (that is, a privilege that my child would work really hard to get).(Required)

Never / Not Yet

Rarely

Often

Almost Always

10. The provider worked with us to identify rewards for my child.(Required)

Never / Not Yet

Rarely

Often

Almost Always

11. The provider made sure that rewards included a balance between vouchers (such as gift cards) that the provider provided and privileges that I provided.(Required)

Never / Not Yet

Rarely

Often

Almost Always

12. The provider made sure that any rewards given to or withheld from my child would motivate him/her to stop using drugs.(Required)

Never / Not Yet

Rarely

Often

Almost Always

13. The provider helped me focus on rewarding abstinence rather than focusing on punishment for drug use.(Required)

Never / Not Yet

Rarely

Often

Almost Always

14. The provider used the checkbook, or another similar system, to track my child's points.(Required)

Never / Not Yet

Rarely

Often

Almost Always

15. The provider tested my child for drug use using a drug screen.(Required)

Never / Not Yet

Rarely

Often

Almost Always

16. The provider made sure that I tested my child for drug use using a drug screen.(Required)

Never / Not Yet

Rarely

Often

Almost Always

17. The provider made sure that an ABC Assessment was completed after each drug screen, regardless of whether the result was positive or negative.

Never / Not Yet

Rarely

Often

Almost Always

18. The provider made sure that I provided or withheld the Most Valued Privilege based on my child's drug screen results.

Never / Not Yet

Rarely

Often

Almost Always

19. The provider made sure that positive or negative consequences were given based on the results of my child's drug screen.

Never / Not Yet

Rarely

Often

Almost Always

20. The provider made sure the drug screens were administered frequently enough to catch drug use.

Never / Not Yet

Rarely

Often

Almost Always

21. The provider made sure the drug screens were administered randomly (at times my child was not expecting it).

Never / Not Yet

Rarely

Often

Almost Always

22. The provider made sure strategies were used to prevent my child from trying to alter the results of his/her drug screens.

Never / Not Yet

Rarely

Often

Almost Always

23. The provider made sure that drug screens were administered at times when my child was more likely to use drugs.

Never / Not Yet

Rarely

Often

Almost Always

24. The provider worked with us on a Self-Management Plan regarding my child's drug use.(Required)

Never / Not Yet

Rarely

Often

Almost Always

25. The provider made sure that my child's Self-Management Plan was based on information we had provided in ABC Assessments.(Required)

Never / Not Yet

Rarely

Often

Almost Always

26. The provider helped us think of ways to rearrange our environment to help my child avoid situations that might cause or "trigger" drug use.(Required)

Never / Not Yet

Rarely

Often

Almost Always

27. The provider helped my child think of ways to avoid situations that might cause or "trigger" drug use.(Required)

Never / Not Yet

Rarely

Often

Almost Always

28. The provider made sure that the drug avoidance strategies were best suited for my child's circumstances, peer group, and personality.(Required)

Never / Not Yet

Rarely

Often

Almost Always

29. The provider helped my child think of the costs and benefits of different drug avoidance strategies.(Required)

Never / Not Yet

Rarely

Often

Almost Always

30. The provider helped my child practice drug avoidance strategies.(Required)

Never / Not Yet

Rarely

Often

Almost Always

31. The provider helped my child think of ways to refuse drugs.(Required)

Never / Not Yet

Rarely

Often

Almost Always

32. The provider made sure that the drug refusal strategies were best suited for my child's circumstances, peer group, and personality.(Required)

Never / Not Yet

Rarely

Often

Almost Always

33. The provider helped my child think of the costs and benefits of different drug refusal strategies.(Required)

Never / Not Yet

Rarely

Often

Almost Always

34. The provider helped my child practice drug refusal strategies.(Required)

Never / Not Yet

Rarely

Often

Almost Always

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